Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate

Abstract

Purpose To assess long-term renal function and micturition pattern of males submitted to transurethral resection of the prostate (TURP) for moderate-to-severe lower urinary tract symptoms (LUTS) after renal transplantation (RT). To investigate the role of clinical and urodynamic (UD) parameters for bladder outlet obstruction (BOO) diagnosis in these patients. Methods Retrospective data analysis of ≥ 50 years old patients who underwent RT between 01/2005 and 12/2016. Patients with moderate-to-severe LUTS after RT who underwent a urologic evaluation and a UD study were included. TURP was performed in case of BOO diagnosis. Kidney function and micturition patterns were evaluated before, 3, 12, 24, 36, and 48 months after TURP. Predictors of BOO were assessed at univariable and multivariable logistic regression models. Statistical analysis was performed with STATA16. Results 233 male patients ≥ 50 years underwent RT. 71/233 (30%) patients developed voiding LUTS. 52/71 (73%) patients with moderate-to-severe LUTS underwent UD. TURP was performed in 36/52 (69%) patients, with BOO diagnosis. Median (interquartile range) follow-up was 108 (75–136) months. Maximum flow at flowmetry (Qmax), International Prostate Symptom Score and post-voided residual volume improved significantly after surgery. Serum creatinine decreased and glomerular filtration rate improved significantly at follow-up, especially when TURP was performed ≤ 6 months from RT. At the multivariable model, bladder capacity ≥ 300 mL (OR = 1.74, CI 95% 1.03–3.15, p = 0.043) and detrusor pressure at Qmax (OR = 2.05, CI 95% 1.48–3.02, p = 0.035) were the independent predictors of BOO. Conclusion RT patients with moderate-to-severe LUTS at risk for BOO and graft failure are better identified by UD than clinical parameters. Bladder capacity and voiding pressure are key for the early diagnosis of BOO.

Late Changes in Renal Volume and Function after Proton Beam Therapy in Pediatric and Adult Patients: Children Show Significant Renal Atrophy but Deterioration of Renal Function Is Minimal in the Long-Term in Both Groups

“…For adult males, benign prostatic hyperplasia (BPH) is a common condition that may lead to ureteral obstruction and subsequent kidney dysfunction and may increase the risk of radiation-associated damage. Even a slight amount of urinary obstruction due to prostate enlargement in male adults has been associated with kidney function deterioration [53]. In our study, only one adult male was found to have signs of BPH, but this did not further lead to ureteral obstruction or a reduction in kidney function.…”

Incidence of and Risk Factors for Recurrent Urinary Tract Infections in Renal Transplant Recipients

“…Urodynamic investigations after RTx seem to have high sensitivity for diagnosing bladder outlet obstruction in male patients after RTx. A study of 233 male RTx patients showed that 67% of men referred for urodynamic investigation after RTx were diagnosed with obstruction and TURP significantly relieved their lower urinary tract symptoms, using the International Prostate Symptom Score questionnaire before and after TURP [23] . Five patients in our study received TURP, of whom three still suffer from rUTIs after TURP.…”

Urodynamics in the Transplant Population

“…In the non-KT popupation, an RCT performed across 26 hospitals in England randomized 820 men seeking potential intervention for bothersome LUTS to UDS or standard care and found UDS did not impact surgical rates [57]. However, in one study by Righetto et al, researchers retrospectively looked at 233 male KT patients > 50 years of age to investigate the role of UDS in diagnosing BOO in this population [58]. Thirty percent (71/233) of patients developed lower urinary tract symptoms (LUTS) and 73% of these patients (52/71) underwent UDS.…”